Health Care Options if You Can’t Get Medicare Yet

Inevitably, in a system that is as patchworked together as American health care, some people slip through the net and don't qualify for Medicare when they might need it. For example, consider the following situations:

You’re under 65 and have qualified for disability payments, but you must wait up to two years for Medicare coverage.

You’re 65 or older but you’re a legal immigrant who hasn’t yet lived in the United States for the five years required to qualify for Medicare.

You have only a few years to go before getting Medicare, but you’ve lost (or never had) a job with health benefits and you’re in poor health.

You’ve had health insurance from your spouse’s employment but he or she is older than you and is now retiring, losing employer benefits for both of you. Your spouse can join Medicare, but what about you?

In any of these situations, you’ll be anxious to know how you can get health care while waiting for Medicare. Here are some possibilities to check out and consider — though keep in mind that not all of them are available to everybody.

Land a job with health benefits

A job that comes with health benefits is always the best option if you or your spouse can get access to one. By law, employers that provide health insurance (and have 20 or more employees) must offer the same benefits, including spousal coverage, to all employees regardless of age, health status, or preexisting medical conditions.

What if you have no employer insurance of your own, you’re younger than your spouse, and he or she is contemplating retirement? Some employers continue to insure a younger spouse after the employee has retired until the younger spouse also reaches Medicare age or to provide retiree benefits that cover both of them.

But very often the younger spouse is just left out in the cold. If you’re in this situation, the best solution is for your spouse to continue working until you become eligible for Medicare if at all possible. If it isn’t, read on.

Pay for COBRA temporary insurance

The COBRA law (short for the Consolidated Omnibus Budget Reconciliation Act of 1986) allows most people who’ve left or lost a job to continue health coverage through their former employer for up to 18 months by paying the full premiums (the employer’s share as well as their own).

If eligible, spouses and dependent children can receive this coverage even if the departing employees don’t take it themselves.

If you take COBRA and then become eligible for Medicare, your COBRA benefits cease. But your spouse may then become eligible for COBRA coverage for a longer period — up to 36 months. Some state laws also allow COBRA coverage for extended periods.

You must apply for COBRA within a certain time frame of leaving your job, so pay attention to deadlines.

Purchase individual insurance from January 1, 2014, on

Starting in 2014, the health care law (the Affordable Care Act of 2010, often known as ObamaCare) allows people who are uninsured to buy health insurance through state insurance exchanges.

The idea is that if you don’t have health insurance from an employer or the government (such as Medicare and Medicaid), you’ll be able to comparison-shop in a one-stop online marketplace and choose from a menu of different health care plans. (The plans are said to be similar to those that are available to federal employees, including members of Congress.)

Insurance companies selling policies through the state exchanges can charge older folks more than younger ones — and they can also add surcharges of up to 50 percent on the premiums of smokers — but they can’t deny or limit coverage or charge higher premiums based on past or present health conditions.

How much these insurance policies will cost or how affordable they’ll be isn’t clear. The law provides subsidies or tax credits for individuals and families whose incomes are under a certain level to buy policies at lower cost, and it makes Medicaid (the state-run health care safety net) available to many more people of all ages.

However, under a 2013 ruling, the Supreme Court allowed individual states to decide whether to expand Medicaid, and not all states will do so. For up-to-date info, contact your State Health Insurance Assistance Program (SHIP); see Appendix A for its phone number.

You can find information about the new state insurance exchanges and details of the health care plans that will be available through them on the Internet from October 1, 2013 on. Go to Healthcare.gov for links to insurance options available in your state and enrollment information.

Under the new law, people who don’t buy health insurance will be liable to a tax penalty. (Those who are liable for the penalty but don’t pay it may lose future tax refunds, but they can’t be jailed or have a lien put on their property.) However, you won’t have to pay it if any of the following is true:

You don’t have to file tax returns.

The cheapest insurance plan would cost more than 8 percent of your income.

You can demonstrate financial hardship.

You’re a Native American.

You’re part of a religious group that qualifies for tax exemptions.

You’re in prison.

You don’t need to buy extra health insurance, and therefore can’t be penalized, if you have Medicare or Medicaid.

Get health care without insurance

If you can’t buy insurance you can afford and don’t qualify for assistance, you may still be able to get medical care from community clinics that provide care for uninsured people for free, at low cost, or according to your ability to pay. To find contact information for any clinics available in your area, go to the U.S. Health Resources and Services Administration directory.